Camzyos™ (mavacamten) (Revised)

By October 26, 2025, implement the following: (1) Billing and prior authorization teams must establish new PA request workflow requiring all five initial criteria be documented and verified before claim submission for Camzyos—specifically: HCM diagnosis, obstruction confirmation via imaging, NYHA Class II-III symptoms, LVEF >55%, and evidence of prior beta-blocker or calcium channel blocker trial/intolerance/contraindication. (2) Providers ordering Camzyos must confirm enrollment in the Camzyos REMS program and attest to all eligibility criteria in PA submissions. (3) For renewal requests (plan year), update PA templates to require: current LVEF documentation (must be >50%), clinical improvement evidence (labs, symptom improvement, patient outcomes), and provider attestation that patient will not receive septal reduction therapy concurrently. (4) Flag any claims missing REMS program enrollment verification from prescriber, pharmacy, or patient—these will be denied. (5) Update billing software decision trees to reject initial requests if LVEF is ≤55% or renewal requests if LVEF is ≤50%, with educational notes about black box heart failure risk. Failure to obtain prior authorization or submit required documentation will result in claim denials. Contact Humana PAL portal (www.humana.com/PAL) for claim code mapping if needed.